Corneal topography-based target warping

ABSTRACT

Systems and methods for treating a tissue of an eye with a laser beam include at least one processor that determines angles between a curved surface and a laser beam, controlling an ablative treatment in response to the angles. Angles between a surface of a cornea and a laser beam may be mapped over a treatment area. A mapped area may include an apex of a cornea displaced from a center of a pupil of an eye. Ablation properties may be determined locally in response to the incident angle of a laser beam with respect to a local slope of a tissue surface. The treatment area may be ablated using local ablation properties to form a desired surface shape.

CROSS-REFERENCE TO RELATED APPLICATION

This is a non-provisional patent application which claims priority fromU.S. Provisional Patent Application No. 60/389,090 filed Jun. 13, 2002,the full disclosure of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention is generally related to correction of refractiveerrors and aberrations of the eye. The invention provides devices,systems, and methods for measurement and correction of optical errors ofoptical systems, and is particularly well suited for correctingrefractive optical aberrations of the eye.

Known laser eye surgery procedures generally employ an ultraviolet orinfrared laser to remove a microscopic layer of stromal tissue from thecornea of the eye. Examples of laser eye surgery procedures includephotorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK),laser assisted in situ keratomileusis (LASIK), laser epithelialkeratomileusis (LASEK), and the like. A laser typically removes aselected shape of a corneal tissue, often to correct refractive errorsof an eye. Ultraviolet laser ablation results in photodecomposition of acorneal tissue, but generally does not cause significant thermal damageto adjacent and underlying tissues of an eye. Irradiated molecules arebroken into smaller volatile fragments photochemically, directlybreaking intermolecular bonds.

Laser ablation procedures can remove a targeted amount stroma of acornea to change a cornea's contour for varying purposes, such as forcorrecting myopia, hyperopia, astigmatism, and the like. Control over adistribution of ablation energy across a cornea may be provided by avariety of systems and methods, including use of ablatable masks, fixedand moveable apertures, controlled scanning systems, eye movementtracking mechanisms, and the like. In known systems, a laser beam oftencomprises a series of discrete pulses of laser light energy, with atotal shape and amount of tissue removed being determined by a shape,size, location, and/or number of laser energy pulses impinging on acornea. A variety of algorithms may be used to calculate the pattern oflaser pulses used to reshape a cornea so as to correct a refractiveerror of an eye. Known systems make use of a variety of forms of lasersand laser energy to effect a correction, including infrared lasers,ultraviolet lasers, femtosecond lasers, wavelength multipliedsolid-state lasers, and the like. Alternative vision correctiontechniques make use of radial incisions in a cornea, intraocular lenses,removable corneal support structures, and the like.

Known corneal correction treatment methods have generally beensuccessful in correcting standard vision errors, such as myopia,hyperopia, astigmatism, and the like. By customizing an ablation patternbased on wavefront measurements, it may be possible to correct minoraberrations so as to reliably and repeatedly provide visual acuitygreater than 20/20. Such detailed corrections will benefit from anextremely accurate ablation of tissue.

Known methods for calculation of a customized ablation pattern usingwavefront sensor data generally involves mathematically modeling asurface of the cornea using expansion series techniques. Morespecifically, Zernike polynomials have been employed to model thecorneal surface and refractive aberrations of the eye. Coefficients of aZernike polynomial are derived through known fitting techniques, and anoptical correction procedure is then determined using a shape indicatedby a mathematical series expansion model.

Work in connection with the present invention suggests that the knownmethodology for determining laser ablation treatments based on wavefrontsensor data and spectacles may be less than ideal. The known techniquestypically do not take into account a detailed ablative interaction of alaser beam with a detailed anatomy of a tissue surface of an eye.

In light of the above, it would be desirable to provide improvedablation techniques, particularly for refractive correction purposes.

BRIEF SUMMARY OF THE INVENTION

The present invention provides systems and methods for treating a tissueof an eye with a laser beam. A local ablation property is determinedbased at least in part on an angle of an incident laser beam with asurface of a tissue. A treatment area is ablated using local ablationproperties.

In a first aspect, the invention comprises a method of treating a corneaof a patient's eye with a laser beam. Angles between a surface of acornea and a laser beam are mapped over a treatment area. Ablationproperties are determined locally across a treatment area in response tomapped angles so as to formulate a treatment plan using local ablationproperties. A treatment area is ablated according to the treatment planto form a desired shape in a surface.

In some embodiments, an angle of a laser beam may be substantiallyparallel to an optical axis of an eye. A mapped area includes an apex ofa cornea and an apex of a cornea is displaced from a center of a pupilof an eye. A desired shape has a center, and a center of a desired shapemay be aligned with a center of a pupil of an eye. A virtual shape maybe adjusted from a first virtual shape to a second virtual shape. Afirst virtual shape may represent a depth of material removed from anarea to form a desired shape. A second virtual shape may be formed froma first virtual shape in response to the mapped angles. In anembodiment, a depth of a second virtual shape may be greater than adepth of a first virtual shape. In another embodiment, a depth of asecond virtual shape may be less than a depth of a first virtual shape.A desired shape may be based at least in part on a result of measurementselected from a group consisting of an aberration measurement of an eye,a refractive measurement of an eye, and a topography measurement of aneye.

In another aspect, the invention comprises a system for treating acornea of a patient's eye with a laser beam. The system includes a laseremitting a beam of an ablative light energy and at least one processor.At least one processor has a computer program mapping angles between asurface of a cornea and a laser beam. At least one processor determineslocal ablation properties of a cornea in response to mapped angles. Atleast one processor has a computer program controlling an ablativetreatment in response to local ablation properties. A treatment forms adesired shape in a surface.

In some embodiments, an angle of a laser beam may be substantiallyparallel to an optical axis of an eye. A mapped area may include an apexof a cornea, and an apex of a cornea may be displaced from a center of apupil of an eye. A desired shape may have a center, and a center of adesired shape may be aligned with a center of a pupil of an eye. Atleast one processor having a computer program may include a firstvirtual shape and a second virtual shape. A first virtual shape mayrepresent a depth of material removed from an area to form a desiredshape, and a second virtual shape may be formed from a first virtualshape in response to mapped angles. In an embodiment, a depth of asecond virtual shape may be greater than a depth of a first virtualshape. In another embodiment, a depth of a second virtual shape may beless than a depth of a first virtual shape. A desired shape may be basedat least in part on a result of measurement selected from a groupconsisting of an aberration measurement of an eye, a refractivemeasurement of the eye, and a topography measurement of the eye.

In a further aspect, the invention comprises a system for treating acornea of an eye with a laser beam. A system includes a laser emitting abeam of an ablative light energy and at least one processor having acomputer program. At least one processor determines angles between acurved surface and a laser beam. At least one processor has a computerprogram controlling an ablative treatment in response to angles betweena curved surface and a laser beam. A treatment forms a desired shape ina surface.

In specific embodiments, at least one processor determines localablation properties of a cornea in response to angles between a curvedsurface and a laser beam. An angle of a laser beam is substantiallyparallel to an optical axis of an eye. A mapped area includes an apex ofa cornea and an apex of a cornea is displaced from a center of a pupilof an eye. A desired shape has a center, and a center of a desired shapeis aligned with a center of a pupil of an eye. At least one processorhas a computer program including a first virtual shape and a secondvirtual shape. A first virtual shape represents a depth of materialremoved from an area to form a desired shape. A second virtual shape isformed from a first virtual shape in response to mapped angles. In anembodiment, a depth of a second virtual shape is greater than a depth ofa first virtual shape. In another embodiment, a depth of a secondvirtual shape is less than a depth of a first virtual shape. A desiredshape is based at least in part on a result of a measurement selectedfrom a group consisting of an aberration measurement of an eye, arefractive measurement of the eye, and a topography measurement of aneye.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a laser system ablating a tissue surface in accordwith an embodiment of the present invention.

FIG. 1A is a perspective view of a laser ablation system forincorporating the present invention.

FIGS. 2 and 3 schematically illustrate a laser beam delivery system forselectively directing a laser beam onto a corneal tissue in accord withan embodiment of the present invention.

FIG. 4 is a functional block diagram illustrating a control architectureof an ablation system as in FIG. 1A in accord with an embodiment of thepresent invention.

FIG. 5 is a flow chart schematically illustrating a method fordetermining a corneal ablation treatment program in accord with anembodiment of the present invention.

FIG. 6 illustrates a laser treatment table in accord with an embodimentthe present invention.

FIG. 7 illustrates a surface topography of a cornea in accord with anembodiment of the present invention.

FIG. 8 illustrates local surface angles of a corneal surface topographyas in FIG. 7 as surface normal vectors in accord with an embodiment ofthe present invention.

FIG. 8A illustrates a center of a pupil of an eye in relation to acenter of a corneal topography measurement in accord with an embodimentof the present invention.

FIG. 8B illustrates a laser surgery system aligned with a center of aneye in accord with an embodiment of the present invention.

FIG. 9 illustrates angles of incidence of several rays of a laser beamincident on a surface of a cornea in accord with an embodiment of thepresent invention.

FIG. 9A illustrates angles of incidence of several parallel rays of alaser beam incident on a surface of a cornea in accord with anembodiment of the present invention.

FIG. 10 illustrates laser beams simultaneously overlapping on a surfaceof a cornea in accord with an embodiment of the present invention.

FIG. 10A illustrates angles of incidence of simultaneously overlappingrays of laser beams incident on a surface of a cornea in accord with anembodiment of the present invention.

FIG. 11 illustrates an ablation rate of a corneal tissue as related to afluence of a laser beam applied to a tissue surface.

FIG. 12 illustrates a fraction of a light energy transmitted into acorneal tissue as related to an angle of incidence of a laser beam.

FIG. 13 illustrates a fluence factor as related to an incident angle ofa laser beam in accord with an embodiment of the present invention.

FIG. 14 illustrates an ablation rate relative to an ablation rate atnormal incidence in accord with an embodiment of the present invention.

FIG. 15 illustrates a desired predetermined ablation shape as a firstvirtual surface warped to form a second virtual surface in accord withan embodiment of the present invention.

FIG. 16 illustrates a crater of material removed with a single pulse ofa laser beam as a first virtual surface warped to form a second virtualsurface in accord with an embodiment of the present invention.

FIG. 17 illustrates a laser beam incident upon a corneal surface duringa LASIK surgical procedure in accord with an embodiment of the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is particularly useful for enhancing the accuracyand efficacy of laser eye surgical procedures, such as photorefractivekeratectomy (PRK), phototherapeutic keratectomy (PTK), laser assisted insitu keratomileusis (LASIK), laser epithelial keratomileusis (LASEK) andthe like. Preferably, the present invention can provide enhanced opticalaccuracy of refractive procedures by improving a corneal ablation of arefractive treatment program. Hence, while the system and methods of thepresent invention are described primarily in a context of a laser eyesurgery system, it should be understood techniques of the presentinvention may be adapted for use in alternative eye treatment proceduresand systems such as spectacle lenses, intraocular lenses, contactlenses, corneal ring implants, collagenous corneal tissue thermalremodeling, and the like.

The techniques of the present invention can be readily adapted for usewith existing laser systems, wavefront sensors, corneal topographysystems, phoropters and other optical measurement devices. By providinga more detailed (and hence, less prone to alignment and other errors)methodology for determining a laser treatment plan, the presentinvention may facilitate sculpting of the cornea so that treated eyesregularly exceed a normal 20/20 threshold of desired vision.

As used herein an “optical tissue surface” may encompass a theoreticaltissue surface derived from an optical measurement of light refractionof an eye (exemplified by wavefront sensor data and manifest refractiondata), an actual tissue surface, and/or a tissue surface formed forpurposes of treatment (for example, by incising corneal tissues so as toallow a flap of the corneal epithelium to be displaced and expose theunderlying stroma during a LASIK procedure).

Systems and methods for measuring a refractive error of an eye such asspherical defocus and cylindrical astigmatism having an axis are wellknown in the optometric and ophthalmic fields. Examples of measurementsof a refractive error of an eye are manifest, cycloplegic, andretinoscopic refraction. U.S. Pat. No. 5,163,934, the full disclosure ofwhich is incorporated herein by reference, describes a shape of tissueto be removed from a cornea of an eye to correct a refractive error ofan eye. Systems and methods for measuring a corneal topography of an eyeare well known in the optometric and ophthalmic fields. For example,U.S. Pat. Nos. 4,761,071, 4,995,716, 5,406,342, 6,396,069, 6,116,738,4,540,254 and 5,491,524, the full disclosures of which are incorporatedherein by reference, describe systems and methods for measuring acorneal topography of an eye. Systems and methods for determining anablation location and shape using corneal topography are described inU.S. Pat. Nos. 6,245,059, 6,129,722 and 5,843,070, the full disclosuresof which are incorporated herein by reference.

Wavefront sensors will typically measure aberrations and other opticalcharacteristics of an entire optical tissue system. Data from such awavefront sensor may be used to generate an optical tissue surface froman array of optical gradients. In some instances, an optical tissuesurface may be referred to as a wavefront elevation map. An opticaltissue surface may not precisely match an actual tissue surface. Forexample, optical gradients will show effects of aberrations, which areactually located throughout an ocular tissue system. Nonetheless,corrections imposed on an optical tissue surface so as to correctaberrations derived from gradients should correct an optical tissuesystem. Systems and methods for measuring and correcting aberrations ofan optical tissue surface of eye based on wavefront elevation maps aredescribed in U.S. Pat. Nos. 5,777,719, 6,042,012, 6,095,651, 6,199,986,6,271,914 and 6,217,915, the full disclosures of which are incorporatedherein by reference.

In correcting an optical tissue surface of an eye, a shape of tissue tobe removed is typically determined prior to ablation. A predeterminedshape is often the result of a combination of refractive error,wavefront sensor and topography measurements as described above.

A laser ablating a surface of an eye is illustrated in FIG. 1 inaccordance with an embodiment of the invention. An eye 2 is illustratedin cross section as being ablated by a laser system 10 having a laser 12emitting a beam 14 of an ablative light energy. An eye 2 has a cornea 4.An eye 2 has a pupil 11 formed in an iris 9. A cornea 4 has a surface 6.A surface 6 of a cornea 4 has a local surface angle 7. A local surfaceangle 7 is preferably a surface normal vector 7 a, but can be anyrepresentation of a local slope of surface 6. An eye 2 has at least oneaxis, for example an optical axis 5. An optical axis 5 of an eye 2 isaligned with a system 10. A desired predetermined shape 8 is formed in asurface 6 with a series of pulses of a laser beam 14 of an ablativelight energy.

As tissue ablates from surface 6 to form predetermined a shape 8, anamount of tissue ablated with each pulse of laser beam 14 varies with anangle between a surface angle 7 and a laser beam 14. Typically, anamount of tissue removed with a pulse of a laser beam 14 will decreaseas a local surface having an angle 7 faces away from a laser beam 14. Bydetermining a local amount of ablation from a local angle between alocal surface angle and a local angle of laser beam incident on thelocal surface, a treatment program will more accurately calculate adistribution pattern of a series of pulses to form a desiredpredetermined shape 8.

Referring now to FIG. 1A, a laser eye surgery system 10 forincorporating the present invention includes a laser 12 that produces alaser beam 14. Laser delivery optics 16 are in a path of laser beam 14.Delivery optics 16 direct laser beam 14 to an eye of a patient P. Adelivery optics support structure (not shown here for clarity) extendsfrom a frame 18 supporting laser 12. An input device 20 is used to alignlaser system 10 in relation to an eye of a patient P. A microscope 21 ismounted on the delivery optics support structure, the microscope oftenbeing used to image a cornea of an eye. In various embodiments, a lasereye surgery system 10 includes at least some portions of a Star S3Active Trak™ Excimer Laser System available from VISX, INCORPORATED ofSanta Clara, Calif.

While an input device 20 is here schematically illustrated as ajoystick, a variety of input components may be used. Suitable inputcomponents may include trackballs, touch screens, or a wide variety ofalternative pointing devices. Still further alternative input componentsinclude keypads, data transmission mechanisms such as an Ethernet,intranet, Internet, a modem, or the like.

A laser 12 generally comprises an excimer laser and ideally comprises anargon-fluoride laser producing pulses of laser light having a wavelengthof approximately 193 nm. A pulse of laser light typically has a fixedpulse duration having a full width half maximum (FWHM) of about 15 nanoseconds during a treatment. Laser 12 is preferably designed to provide afeedback stabilized fluence at the patient's eye, delivered via deliveryoptics 16. The present invention may also be useful with alternativesources of ultraviolet or infrared radiation, particularly those adaptedto controllably ablate a corneal tissue without causing significantdamage to adjacent and/or underlying tissues of the eye. The lasersystem may include, but is not limited to, excimer lasers such asargon-fluoride excimer lasers (producing laser energy with a wavelengthof about 193 nm), solid state lasers, including frequency multipliedsolid state lasers such as flash-lamp and diode pumped solid statelasers. Exemplary solid state lasers include UV solid state lasers(approximately 193-215 nm) such as those described in U.S. Pat. Nos.5,144,630 and 5,742,626, Borsuztky et al., “Tunable UV Radiation atShort Wavelengths (188-240 nm) Generated by Sum Frequency Mixing inLithium Borate”, Appl. Phys. 61:529-532 (1995), and the like. Laserenergy may comprise a beam formed as a series of discreet laser pulses.A variety of alternative lasers might also be used. Hence, although anexcimer laser is the illustrative source of an ablating beam, otherlasers may be used in the present invention.

Laser 12 and delivery optics 16 will generally direct laser beam 14 toan eye of patient P under direction of a processor 22. Processor 22 willoften selectively adjust laser beam 14 to expose portions of the corneato pulses of laser energy so as to effect a predetermined sculpting of acornea and alter refractive characteristics of an eye. In manyembodiments, both laser 14 and a laser delivery optical system 16 willbe under computer control of processor 22 to effect a desired lasersculpting process, with processor 22 effecting (and optionallymodifying) a pattern of laser pulses. A pattern of pulses may bysummarized in a treatment table listing of machine readable data of atangible media 29. A treatment table may be adjusted according tofeedback input into processor 22 from an automated image analysis system(manually input into processor 22 by a system operator) in response tofeedback data provided from an ablation monitoring system feedbacksystem. Such feedback might be provided by integrating a wavefrontmeasurement system described below with a laser treatment system 10, andprocessor 22 may continue and/or terminate a sculpting treatment inresponse to feedback, and may optionally also modify a planned sculptingbased at least in part on feedback.

Laser beam 14 may be adjusted to produce a desired sculpting using avariety of alternative mechanisms. A laser beam 14 may be selectivelylimited using one or more variable apertures. An exemplary variableaperture system having a variable iris and a variable width slit isdescribed in U.S. Pat. No. 5,713,892, the full disclosure of which isincorporated herein by reference. A laser beam may also be tailored byvarying a size and offset of a laser spot from an axis of an eye, asdescribed in U.S. Pat. No. 5,683,379, and as also described inco-pending U.S. patent application Ser. Nos. 08/968,380, filed Nov. 12,1997; and 09/274,999 filed Mar. 22, 1999, the full disclosures of whichare incorporated herein by reference.

Still further alternatives are possible, including scanning a laser beamover a surface of an eye and controlling a number of pulses and/or dwelltime at each location, as described, for example, by U.S. Pat. No.4,665,913 (the full disclosure of which is incorporated herein byreference); using masks in an optical path of laser beam 14 which ablateto vary a profile of a beam incident on a cornea, as described in U.S.patent application Ser. No. 08/468,898, filed Jun. 6, 1995 (the fulldisclosure of which is incorporated herein by reference); hybridprofile-scanning systems in which a variable size beam (typicallycontrolled by a variable width slit and/or variable diameter irisdiaphragm) is scanned across the cornea as described in U.S. Pat. Nos.6,319,247; 6,280,435; and 6,203,539, the full disclosures of which areincorporated herein by reference; or the like. The computer programs andcontrol methodology for these laser pattern tailoring techniques arewell described in the patent literature.

Additional components and subsystems may be included with laser system10, as should be understood by those of skill in the art. For example,spatial and/or temporal integrators may be included to control thedistribution of energy within the laser beam, as described in U.S. Pat.Nos. 5,646,791 and 5,912,779 the full disclosures of which areincorporated herein by reference. An ablation effluent evacuator/filter,and other ancillary components of the laser surgery system which are notnecessary to an understanding of the invention, which may be optionallyemployed, need not be described in detail for an understanding of thepresent invention.

Processor 22 may comprise (or interface with) a conventional PC systemincluding standard user interface devices such as a keyboard, a displaymonitor, and the like. Processor 22 will typically include an inputdevice such as a magnetic or optical disk drive, an internet connection,or the like. Such input devices will often be used to download acomputer executable code from a tangible storage media 29 embodying anymethods of the present invention. Tangible storage media 29 may comprisea floppy disk, an optical disk, a data tape, a volatile or non-volatilememory, or the like, and a processor 22 will include memory boards andother standard components of modem computer systems for storing andexecuting a computer program code. Tangible storage media 29 mayoptionally embody wavefront sensor data, wavefront gradients, awavefront elevation map, a treatment map, a corneal topography map, ameasurement of a refraction of an eye, and an ablation table.

Referring now to FIG. 2, a laser beam delivery system 16 for directing alaser beam 14 at an eye 2 will often include a number of mirrors 30, aswell as one or more temporal integrators 32 which may adjust (orotherwise tailor) an energy distribution across a laser beam. Laser 12will often comprise an excimer laser as described above.

In an exemplary embodiment, a variable aperture 34 changes a diameterand/or slot width to profile laser beam 14, ideally including both avariable diameter iris and a variable width slot. A prism 36 separateslaser beam 14 into a plurality of beamlets, which may partially overlapon eye 2 to smooth edges of an ablation or “crater” formed from eachpulse of a laser beam. Referring now to FIGS. 2 and 3, an offset module38 includes motors 40 which vary an angular offset of an offset lens 42,and which also change a radial orientation of an offset. Hence, offsetmodule 38 can selectively direct laser beam 14 at a desired lateralregion of a cornea. A structure and method for using a laser beamdelivery system 16 and an offset module 38 are more fully described inU.S. Pat. Nos. 6,331,177; 6,203,539; 5,912,775; and 5,646,791 the fulldisclosures of which are incorporated herein by reference.

Referring now to FIG. 4, a control system of a laser system 10 isschematically illustrated according to principles of the presentinvention. A processor 22 enables precise control of laser system 10 tosculpt a surface shape according to a laser treatment table 52. Aprocessor 22, which generally comprises a PC workstation, makes use of acomputer program stored on a tangible media 29 to generate treatmenttable 52. Processor 22 includes a library 44 of treatments as describedin U.S. Pat. No. 6,245,059, the full disclosure of which is incorporatedherein by reference. An embedded computer 58 within laser system 10 isin electronic communication with the PC workstation. Alternatively, a PCworkstation may be embedded in laser system 10 and include an embeddedprocessor card in communication with a PC workstation for directing anophthalmic surgery.

Embedded computer 58 is in electronic communication with a plurality ofsensors 56 and a plurality of motor drivers 60. Motor drivers 60 arecoupled to an embedded computer 58 to vary a position and configurationof many of optical components of delivery optics 16 according totreatment table 52. For example, first and second scanning axes 62, 64control a position of an offset lens to move several laser beamlets overa surface of a cornea. Iris motor 66 controls an overall diameter of abeam, and in some cases, a length of light transmitted through avariable width slot. Similarly a slot width driver 68 controls a widthof a variable slot. Slot angle driver 70 controls rotation of a slotabout its axis. Beam angle driver 72 controls beam rotation as effectedby a temporal integrator as described above. A timer 80 controls a timeinterval between pulses of a laser treatment. Timer 80 measures a timeinterval from a previous pulse and generates an interrupt after apredetermined time interval has elapsed. Processor 22 issues a commandfor laser 12 to generate a pulse of laser beam 14 after various opticalelements have been positioned to create a desired crater on eye 2 andafter a measured time interval has elapsed. Treatment table 52 comprisesa listing of all desired craters to be combined so as to effect atreatment therapy.

A flow chart schematically illustrating a method for determining acorneal ablation treatment plan is illustrated in FIG. 5 in accord withan embodiment of the present invention. A treatment calculation program136 uses properties of an optical tissue surface 134, corneal topography137, ablative pulse characteristics 138, and laser beam angles 139 todetermine a treatment plan listed in a treatment table 52. Opticaltissue surface 134 includes information related to optical aberrationsof the eye as described above. Corneal topography 137 includes ameasured shape of at least one surface of the cornea, preferably a frontsurface as described above. Corneal topography 137 preferably includesinformation locating a center of a pupil in relation to mapped cornealtopography coordinates. Ablative pulse characteristics 138 includeinformation describing a shape of tissue, or “crater” removed with apulse of a laser beam. Local laser beam angles 139 include informationdescribing several local angles of several rays of at least one laserbeam incident on several locations of a cornea in relation to areference axis, for example an optical axis of an eye as describedabove.

A treatment calculation program 136 combines information from an opticaltissue surface 134 with corneal topography 137 to determine a desiredshape of tissue to be removed from a surface 6 of a cornea 4 to form adesired shape 8 in surface 6. Alternatively, a desired shape of tissueto be removed from a surface 6 may be calculated from an optical tissuesurface, for example from a wavefront elevation map, without usingcorneal topography information. A desired shape of tissue removed ispreferably determined from an optical tissue surface 134 so as to removeregular (spherical and/or cylindrical) and irregular errors of opticaltissues as described above. Alternatively, a desired shape of tissue tobe removed may be determined so as to modify optical tissue surface 134and leave controlled amounts of aberration, for example controlledamounts of aberrations correcting presbyopia.

By combining in a treatment plan an optical tissue surface and ablativelaser pulse characteristics 138 of a particular laser system, atreatment table 52 of ablation pulse locations, sizes, shapes, and/ornumbers can be developed. An exemplary method and system for preparingsuch an ablation table is described in co-pending U.S. patentapplication No. 60/189,633 filed on Mar. 14, 2000 and entitled“Generating Scanning Spot Locations for Laser Eye Surgery,” the fulldisclosure of which is incorporated herein by reference. Sorting ofindividual pulses to avoid localized heating, minimize irregularablations if the treatment program is interrupted, and the like mayoptionally optimize treatment table 52. Preferably, a series of pulsesapplied to an eye are listed in a treatment table and sorted toinitially apply pulses having a small cross sectional dimension followedby pulses having a larger cross sectional dimension. Alternatively, atreatment table may be sorted to apply large diameter pulses to an eyeinitially followed by smaller diameter pulses, and an order of pulsesmay provide pulses having a random size distribution. An eye can then betreated by laser ablation 142 according to a treatment table 52.

Referring now to FIG. 6, several listings from an exemplary lasertreatment table 140 are illustrated. A Patient Name 150, patientidentification number (Patient ID) 154, and treated Eye 156 are listedin table 140. A repetition rate (reprate) 152 is also listed. Arefraction 158 having a sphere of −3 D, a cylinder of −2.25D, an axis of60 degrees and a vertex distance of 0 mm is listed in FIG. 6. A pulsecount 160 as listed in FIG. 6 illustrates a total number of 1079 pulsesapplied to an eye during a treatment. Additional fields of treatmenttable 140 are pulse number 170, iris diameter 172, slit width 174, slitaxis 176, X coordinate 178, and Y coordinate 180.

For each pulse of treatment table 140, a pulse number 170, iris diameter172, slit width 174, slit axis 176, X coordinate 178 and Y coordinate180 are listed. The X coordinate 178 and Y coordinate 180 list X and Ycoordinates of a center of each pulse on a cornea relative to atreatment center during a treatment. An iris diameter field 172 lists adimension across a circular iris diaphragm opening as projected onto aneye in mm for each pulse during treatment as described above. A slitwidth field 174 and a slit axis field 176 list a dimension across and anangle of a variable width slot opening as projected onto an eye asdescribed above. A laser treatment table for scanning a variable widthslot is described in U.S. Pat. No. 6,203,539, the full disclosure ofwhich is incorporated herein by reference.

A map 200 of corneal surface elevation is illustrated in FIG. 7. A map200 has an elevation 202 along a first dimension X 204 and a seconddimension Y 206. For a map 200 of a corneal surface, several localsurface angles are determined over a map 200 of a corneal surface asshown in FIG. 8. Several local surface angles are represented as severallocal surface normal vectors 208. An individual surface normal vector208 a is illustrated. A map 200 of corneal surface elevation 202 isexpressed as a function Z(x,y) of first dimension X 204 and seconddimension Y 206. Based on an elevation map, a surface normal vector 210can be computed from Z(x,y) as:N(x,y)=(Z _(u) ×Z _(v))where Z_(u) and Z_(v) are partial derivatives of the surface at pointZ(x,y). A surface normal vector is preferably normalized to have amagnitude of 1. A normalized surface normal vector is expressed asn(x,y)=N(x,y)/∥N∥

A measurement of a corneal topography of an eye and a pupil of an eyeare illustrated in FIG. 8A. A pupil 11 is formed in an iris 9. Severalrings 210 of light are reflected from a surface of a cornea during atopography measurement of a cornea. In this embodiment, a center of atopography measurement is near a apex of a cornea 5B. A center of apupil 5A is illustrated as displaced from a apex of a cornea 5B. Acenter of a topography measurement is displaced from a center of a pupilby distances Xp and Yp along first and second dimensions X and Yrespectively. Several commercially available corneal topography systemsmeasure a corneal topography of an eye and a center of a pupil of aneye. For example, a Humphrey® Atlas™ Corneal Topography System isavailable from ZEISS HUMPHREY SYSTEMS of Dublin, Calif.

An alignment of an eye with a laser system 10 as described above isillustrated in FIG. 8B. A pupil 11 is formed in an iris 9. A reticule212 is aligned with a center 5A of a pupil 11. In alternate embodiments,a system 10 may be aligned with any center of an eye, for example acenter of a reflected image such as a first Purkinje image, a center ofa dilated pupil and a center of a limbus.

A surgery and an optical tissue surface measurement are centered about apupil of an eye as illustrated in FIG. 9. A center of a pupil 5A of aneye has an associated line of sight passing through a cornea of an eyeas a patient looks at a fixation target. A line of sight is alsoreferred to as a chief ray. A wavefront measurement of an eye iscentered about a pupil of an eye. A topography system generally has acentral coordinate reference near an apex of a cornea 5B. A topographysystem may use any reference point as a coordinate center. Surfacenormal vectors are desirably calculated in relation to a center of apupil. A pupil center in a topography system measurement referencesystem may be expressed as (X_(p), Y_(p)). A separation distance X_(p)from an apex of a cornea 5B to a center of a pupil 5A is illustrated inFIG. 9. In a coordinate system centered about a pupil, surface normalvectors are represented as N(x′,y′) wherex′=x−X _(p)y′=y−Y _(p).

A pupil-centered vector field N(x′,y′) is used to derive a localincident angle map Θ(x′,y′) as a function of local position on a surfaceof an eye. A local incident angle map Θ(x′,y′) describes a local angleat which a laser beam strikes a surface.

As illustrated in FIG. 9, a laser system 10 has a laser 12 that emits alaser beam 14 as described above. Several rays 230 a to 230 e of a laserbeam 14 are illustrated. A local angle of a ray 230 a of laser beam 14incident on a cornea is illustrated as a ray normal vector 220 a. A raynormal vector 220 a representing an angle of a laser beam is preferablya normalized vector (i.e. has a magnitude of one). Several ray normalvectors 220 of a map of ray normal vectors are illustrated in FIG. 9.Mathematically, a map of ray normal vectors is expressed as r(x′,y′). Amap of ray normal vectors is readily calculated for any laser systemwith a ray tracing program. A map of ray normal vectors is calculated inrelation to an optical axis of a laser system 10 that is aligned with acenter, preferably the pupil center 5A, during surgery.

A local incident angle map Θ(x′,y′) describes a local angle between asurface normal vector and a local angle of a laser beam incident on aneye. A local incident angle map Θ(x′,y′) is used to determine localablation properties of a tissue. For each of several local incidentangles, a local tissue ablation property is determined. A treatment istable is generated based at least in part on a local ablation property.

Several local incident angles 222 of a local incident angle map Θ(x′,y′)are illustrated in FIG. 9. A local incident angle 222 a between a localsurface normal vector 208 a and a local ray normal vector 220 a of alaser beam is illustrated. A local angle of incidence 222 a is relatedto a dot product projection of a local ray normal vector 220 a and asurface normal vector 208 a. A local incident angle map Θ(x′,y′) iscalculated from a dot product projection of surface normal vectors 208and several ray normal vectors 220 asΘ(x′,y′)=cos⁻¹ [r(x′,y′)·n(x′,y′)]

In an embodiment illustrated in FIG. 9A, several rays 230 a to 230 e ofa laser beam 14 are incident on a surface 6 of a cornea of an eye 2.several rays 230 a to 230 e of laser beam 14 are parallel. A Z axis 250is perpendicular to a plane of X and Y coordinate references 252, 254respectively. Z axis 250 is parallel to rays 230 a to 230 e. In thisembodiment, a Z axis 250 is parallel to several local ray normal vectors220 and ray normal vector 220 a. A local angle of incidence 222 a isrelated to a dot product projection of a local ray normal vector 220 aand a surface normal vector 208 a as described above. As ray normalvectors 220 are parallel to Z axis 250, a local angle of incidence isrelated to a dot product projection of Z axis 250 and a surface normalvector. A local incident angle map Θ(x′,y′) may be calculated asΘ(x′,y′)=cos⁻¹(N _(z)(x′,y′)/∥N∥)where N_(z) is the z-component of the surface normal and ∥N∥ is themagnitude of a surface normal vector.

In an embodiment illustrated in FIG. 10, a laser beam 14 as describedabove is divided into several smaller laser beams, for example beams14I, 14J and 14K. Laser beams 14I, 14J and 14K overlap and are incidenton a surface 6 of a cornea. Laser beams 14I and 14J are separated by anangle 260. Laser beams 14J and 14K are separated by an angle 262.Systems and methods for multiple beam laser sculpting are described inU.S. Pat. No. 6,331,177, the full disclosure of which is incorporatedherein by reference.

Laser beams 14I, 14J and 14K include rays 230I, 230J and 230K incidenton a common location on a surface 6 of a cornea of an eye 2 asillustrated in FIG. 10A. Ray normal vectors 220I, 220J and 220K describean angular orientation of each of beams 14I, 14J and 14K respectively ata common location on a surface 6. An angle of incidence between each rayand a surface normal vector is calculated as described above. In someembodiments, angles 260 and 262 are small and ray normal vectors 220I,220J and 220 K are assumed to be accurately represented by a single raynormal vector, for example ray normal vector 220J.

A local angle of incidence of a laser beam on a corneal surface is usedto determine local ablation properties. An amount of light locallytransmitted into a tissue is related to an angle of incidence of a laserbeam. Several factors contribute to an amount of light transmitted intoa tissue. Reflection of light energy from a surface is one such factor.Another factor is an effective increase in a size of surface areairradiated by a beam.

An effective fluence of a light beam applied on a surface changes withan angle of incidence of a light beam. A change in an applied fluencewith a change in an angle of incidence is referred to as a cosineeffect. A beam incident on a surface illuminates an increased area as anangle of incidence increases. For a fixed amount of energy along a crosssectional dimension of a laser beam, an increase in an illuminated areawill decrease an amount of energy per unit area applied to a tissue. Aneffective fluence applied to a surface changes as a cosine of an angleof incidence. For example, a laser beam having a cross sectionaldiameter of 1 mm and a fluence of 160 mJ/cm² will irradiate a 1 mm crosssectional diameter of tissue with a fluence of 160 mJ/cm² when an angleof incidence is 0. However, a laser beam having a cross sectionaldiameter of 1 mm and oriented at 45 degrees to a surface will irradiatea cross section of tissue having a length of 1.4 mm along a firstdimension and a length of 1 mm along a second dimension. An effectivefluence applied to a surface will decrease to 110 mJ/cm².

As illustrated in FIG. 11, an amount of tissue ablated with a pulse of alaser beam depends at least in part on an amount of energy per unit areaapplied to a tissue. An ablation rate 266 changes with a fluence 268 oflight energy applied to an eye with a pulse of a laser beam applied. Ata fluence 268 of about 160 mJ/cm², an ablation rate 266 is illustratedas about 0.23 um per pulse for a laser beam at normal incidence. At afluence 268 of 110 mJ/cm², an ablation rate 266 is illustrated as about0.11 um per pulse for a laser beam at normal incidence. Systems andmethods for measuring tissue ablation rates are known, and alternateembodiments may use a different ablation rate 266 for a similar amountof applied fluence 268.

Amounts of light energy reflected from a surface and transmitted througha surface into a tissue change with a change in an angle of incidence ofa light beam. An amount of light energy transmitted into a tissue iscalculated with Fresnel formulae. These formulae are known, and use anindex of refraction and an angle of incidence to determine an amount oflight energy penetrating into a tissue. For an excimer laser asdescribed above polarization is random. In alternate embodiments a laserbeam is polarized. A fraction of light energy transmitted into a tissueis determined by a transmissivity expressed asT(θ_(i)){[(sin 2θ_(i) sin2θ_(t))/(sin²(θ_(i)+θ_(t))cos²(θ_(i)−θ_(t)))]+[(sin 2θ_(i) sin2θ_(t))/(sin²(θ_(i)+θ_(t))]}/2for a randomly polarized light beam, where θ_(i) is an angle ofincidence of a light beam and θ_(t) is a transmitted angle of lightbeam. An angle of incidence θ_(i) of a light beam is related to atransmitted angle θ_(t) by Snell's law. For corneal tissue an index ofrefraction is about 1.377. A transmitted angle θ_(t) is calculated fromSnell's law expressed as: sin θ_(t)=sin θ_(i)/1.377where θ_(i) is an angle of incidence of a light ray.

A fraction 270 of energy transmitted into a corneal tissue isillustrated in FIG. 12. A fraction 270 of energy transmitted into atissue changes with an angle of incidence 272. For an angle of incidence272 of 0, a fraction 270 of light energy transmitted into a tissue isillustrated as 0.975, about 98%. For an angle of incidence 272 of 45degrees a fraction 270 of energy transmitted is illustrated as 0.966,about 97%.

A fluence factor 280 is determined for an angle of incidence 272 asillustrated in FIG. 13. A fluence factor is used to determine an appliedlocal tissue fluence of a laser beam. A fluence factor 280 is a fractionof cross sectional beam energy transmitted through a tissue surface andvaries with an incident angle 272. A fluence factor 280 includes a“cosine effect” and a transmission fraction 270 as described above. Afluence factor 280 including both a cosine projection and a transmissionfraction 270 is illustrated with several dots 284. In alternateembodiments, a fluence factor may include a cosine projection of a beamonto a surface and assume reflectance to be uniform across a mappedcornea as illustrated with a solid line 282. Local tissue fluence isdetermined at a location by multiplying a fluence factor and a fluenceof a laser beam. For a laser beam having a cross sectional fluence of160 mJ/cm² at normal incidence to a surface and a fluence factor of 0.9at 25 degrees, a tissue fluence is a product of 0.9 and 160 equaling 144mJ/cm². Alternate embodiments may use a laser beam having a Gaussianenergy intensity profile distribution. A local fluence may be calculatedby multiplying a fluence factor by a local energy intensity at normalincidence.

For a local angle of incidence of a laser beam, a local fluencetransmitted into a tissue is determined. A local tissue ablation rate isdetermined from a local fluence transmitted into a tissue using a tissueablation rate as related to fluence applied at normal incidence asdescribed above.

An ablation rate relative to ablation at normal incidence 290 isillustrated in FIG. 14 and varies with an incident angle 272. In anembodiment using a fluence factor, a laser beam fluence and tissueablation rate as described above, a local tissue ablation rate relativeto a tissue ablation rate at normal incidence may be determined. Thislocal tissue ablation property may used to adjust a laser beamtreatment. In alternate embodiments, a local tissue ablation raterelative to ablation at normal incidence may be accurately determined bya cosine function of an angle of incidence, for example at small anglesof incidence.

In an embodiment, a predetermined intended ablation shape of tissueremoved from a corneal tissue is adjusted to compensate for localablation properties as illustrated in FIG. 15. In some embodiments, anadjustment of a virtual ablation shape from a first virtual shape to asecond virtual shape may be referred to as warping of an ablationtarget. A predetermined shape of ablation is stored in a memory of aprocessor as a first virtual shape 300. A local incident angle map isused to determine a map of local ablation properties, for example a mapof local ablation rate relative to an ablation rate at normal incidenceas described above. A first virtual shape 300 is adjusted by dividing adepth of a first virtual shape 300 by an amount of relative ablation toform a second virtual shape 302. For example, a first virtual shape 300has a depth 306 of ablation of 10 um at a location. A map of localablation properties determines relative ablation to be 0.9 locally. Asecond virtual shape 302 has a local depth of ablation of 11 um that hasincreased by an amount 308 of 1 um. A treatment plan is determined froma second virtual shape 302 and listed in a treatment table as describedabove. As a series of pulses is applied to an eye, a shape of ablatedtissue matches first virtual shape 300.

In another embodiment, a simulated shape of material removed with eachpulse of a laser beam is adjusted based on local ablation properties asillustrated in FIG. 16. At least one crater of material removed with asingle pulse of a laser beam is stored in a memory of a processor as afirst virtual surface 314. Systems and methods for determining shapes oftissue removed with a laser beam are described in U.S. Pat. Nos.6,315,413 and 6,302,876, the full disclosures of which are incorporatedherein by reference. During a treatment, a final ablated shape ofmaterial removed from a surface is a summation of individual craters oftissue removed with each pulse of a series of laser beam pulses. Todetermine a simulated shape of an ablation, each simulated crater oftissue removed in a series of pulses is adjusted by local ablationproperties. As illustrated in FIG. 16, a crater described by a firstvirtual surface 314 is adjusted using local ablation properties to forma second virtual surface 316. Second virtual surface 316 illustrates acrater of material removed as adjusted based on local ablationproperties. A center of a pupil is illustrated at 5A as described above.As illustrated for a treatment centered about a pupil, first and secondvirtual surfaces 314 and 316 respectively are displaced from a treatmentcenter as may occur during a scanning treatment.

Preferably, a local fluence of light energy transmitted into a tissue isdetermined and a local depth of ablation determined as described above.Alternatively, a depth of ablation may be adjusted by a factor such asan ablation rate relative to an ablation rate at normal incidence asdescribed above. A depth of ablation 310 at a location of first virtualsurface 314 is decreased to a second depth of ablation 312 in secondvirtual surface 316 as adjusted based on local ablation properties. Acenter of a cornea at normal incidence to a laser beam ray isillustrated at 5B as described above. At normal incidence, a depth offirst virtual surface 314 matches a depth of second virtual surface 316.To determine a predetermined shape of tissue removed by a series oflaser beam pulses, several craters are adjusted based on local ablationproperties and combined to determine a total shape of material removed.Each crater of a treatment is adjusted based on local ablationproperties and a treatment plan is calculated and listed as treatmenttable as described above.

In an embodiment, a LASIK surgical eye procedure is performed on an eyeas illustrated in FIG. 17. An eye 2 has a cornea 4. Several rays230A-230E of a laser beam 14 are incident on a surface of a cornea asdescribed above. Several local angles of incidence of rays of laser beam14 are determined as described above. Local tissue ablation propertiesare determined at least in part in response to local incident angles asdescribed above. A flap of corneal tissue 320 is resected from cornea 4,exposing a bed of stromal tissue 322. In a preferred embodiment, severallocal angles of incidence are determined before a flap of corneal tissue320 is resected. In alternate embodiments, several local angles ofincidence and local tissue ablation properties may be determined after aflap of corneal tissue 320 is resected. A laser beam treatment forms adesired ablation shape in cornea 4 as described above. After ablation,flap 320 is repositioned over a bed of stromal tissue 322.

While the above provides a complete and accurate description of specificembodiments of the invention, several changes and adaptations of thepresent invention may be readily made. For example, while specificreference has been made to ablating predetermined shapes based onpre-operative measurements, systems and methods of the present inventionare applicable to any ablation, for example ablation based onintra-operative measurements. While specific reference has been made tocorrecting optical aberrations made with refractive, wavefront andtopography measurements, methods and systems of the present inventioncan be used to ablate any desired shape in tissue based on anymeasurement. Therefore, the scope of the invention is limited solely bythe following claims.

1. A method of treating a cornea of a patient's eye with a laser beam,the method comprising: mapping angles between a surface of the corneaand the laser beam over a treatment area; determining ablationproperties locally across the treatment area in response to the mappedangles; formulating a treatment plan using the ablation properties byadjusting a first virtual ablation shape to form a second virtualablation shape, the first virtual shape representing a depth of materialto be removed from the treatment area to form a desired shape, thesecond virtual shape being formed from the first virtual shape inresponse to the mapped angles and; ablating the treatment area accordingto the treatment plan to form the desired shape in the surface.
 2. Themethod of claim 1 wherein the laser beam is substantially parallel to anoptical axis of the eye.
 3. The method of claim 1 wherein the mappedarea includes an apex of the cornea and the apex of the cornea isdisplaced from a center of a pupil of the eye.
 4. The method of claim 3wherein the desired shape has a center, and the center of the desiredshape is aligned with the center of the pupil of the eye.
 5. The methodof claim 1 wherein a depth of the second virtual shape is greater than adepth of the first virtual shape.
 6. The method of claim 1 wherein adepth of the second virtual shape is less than a depth of the firstvirtual shape.
 7. The method of claim 1 wherein the desired shape isbased at least in part on a result of a measurement selected from thegroup consisting of an aberration measurement of the eye, a refractivemeasurement of the eye and a topography measurement of the eye.